Prevalence of hypertriglyceridemia and its association with extreme cardiovascular risk in patients with acute and chronic coronary syndrome enrolled in a cardiac rehabilitation program

Background: Prevalence of hypertriglyceridemia in patients with Acute and Chronic Coronary Syndrome (ACS and CCS, respectively) in the current era of Low-Density Lipoprotein Cholesterol (LDL-C) targets remains unknown. This study aimed to evaluate the prevalence of triglyceride (TG) levels above 150 mg/dL in ACS and CCS patients enrolled in a Cardiac Rehabilitation (CR) program and to explore its association with extreme cardiovascular (CV) risk. Methods: We included 905 ACS/CCS patients who participated in the CR program at Niguarda Hospital (Milan) between January 1, 2012, and March 28, 2024. Data on demographic, clinical, and laboratory variables were collected. Extreme CV risk was defined as the occurrence of a CV event within two years or the presence of peripheral artery disease or multivessel coronary involvement. Results: TG levels significantly decreased during the CR period (median 116.5, I-III quartiles 87-115 vs. 100, 80-133 mg/dL, p < 0.001), as did LDL-C levels (106.8 +/- 39.3 vs. 64.4 +/- 24.9 mg/dL, p < 0.001). At the end of CR, 17.6 % of patients had TG levels >= 150 mg/dL (15.0 % among those who reached the LDL-C target). In multivariable analysis, each 10 mg/dL increase in TG was associated with a 4.6 % increased risk of extreme CV risk (OR 1.046; 95 %CI 1.007-1.085; p = 0.019). Additionally, hypertriglyceridemia (TG >150 mg/dL) increased the risk of extreme CV risk by 81.5 % (OR 1.815; 95 %CI 1.096-3.007; p = 0.021). Conclusions: Despite high-intensity statin therapy and low LDL-C targets, a significant proportion of patients in CR still exhibited elevated TG levels. Both TG levels and hypertriglyceridemia were strongly associated with the presence of extreme CV risk.